NURS 121L-B Medical-Surgical Nursing Practicum Comprehensive Final
Exam 2026 |WCU
1. A patient’s arterial blood gas (ABG) results show pH 7.30, PaCO2 52 mmHg,
and HCO3 24 mEq/L. Which condition does this reflect?
A. Respiratory Alkalosis
B. Respiratory Acidosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Answer: B
Rationale: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg with a normal
HCO3 indicates that the cause is respiratory in nature, signifying respiratory acidosis.
2. The nurse is caring for a patient with a serum potassium level of 6.2 mEq/L.
Which EKG change is most characteristic of this finding?
A. Prominent U waves
B. Shortened PR interval
C. ST-segment depression
D. Tall, peaked T waves
Answer: D
Rationale: Hyperkalemia (K+ > 5.0 mEq/L) commonly manifests as tall, peaked T waves,
widened QRS complexes, and potentially cardiac arrest if untreated.
,3. Prior to surgery, the patient has not signed the informed consent form. The
surgeon has explained the procedure, but the patient asks the nurse, ‘What are
the risks again?’ What is the nurse’s best action?
A. Explain the risks to the patient and have them sign.
B. Notify the surgeon that the patient needs further clarification.
C. Ask the patient’s spouse to sign the form.
D. Witness the signature since the surgeon already spoke to them.
Answer: B
Rationale: While the nurse can witness a signature, it is the surgeon’s responsibility to
provide the explanation of risks and benefits. If the patient is unclear, the surgeon must be
recalled.
4. During the intraoperative phase, a patient develops muscle rigidity, a rapid
rise in body temperature, and tachycardia. Which medication should the nurse
anticipate administering?
A. Dantrolene sodium
B. Naloxone
C. Atropine sulfate
D. Succinylcholine
Answer: A
Rationale: These are classic signs of Malignant Hyperthermia, a life-threatening reaction to
general anesthesia. Dantrolene is the specific skeletal muscle relaxant used to treat it.
, 5. A nurse is assessing a patient 2 hours post-cholecystectomy. The patient
reports severe abdominal pain and the nurse notes the surgical dressing is
saturated with bright red blood. What is the priority nursing action?
A. Reinforce the dressing and document the findings.
B. Check the patient’s blood pressure and heart rate.
C. Apply an abdominal binder tightly.
D. Change the dressing to a sterile one.
Answer: B
Rationale: Saturated bright red drainage (hemorrhage) requires an immediate assessment
of hemodynamic stability (vitals) to check for shock before notifying the surgeon.
6. Which clinical manifestation is most indicative of Right-Sided Heart Failure?
A. Pulmonary crackles
B. Dyspnea on exertion
C. Peripheral edema and JVD
D. Orthopnea
Answer: C
Rationale: Right-sided heart failure causes systemic congestion, leading to jugular venous
distention (JVD), dependent edema, and hepatomegaly.
7. A patient with COPD is receiving oxygen via nasal cannula at 2L/min. Why
must the nurse be cautious about increasing the flow rate to high levels?
A. It will cause immediate oxygen toxicity.
B. High flow rates cause severe epistaxis in COPD patients.
C. It may suppress the patient’s hypoxic drive to breathe.
D. It will lead to metabolic alkalosis.
Answer: C
Rationale: In some patients with chronic hypercapnia, the stimulus to breathe shifts from
high CO2 to low O2 (hypoxic drive). Excessive O2 can decrease respiratory effort.
Exam 2026 |WCU
1. A patient’s arterial blood gas (ABG) results show pH 7.30, PaCO2 52 mmHg,
and HCO3 24 mEq/L. Which condition does this reflect?
A. Respiratory Alkalosis
B. Respiratory Acidosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Answer: B
Rationale: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg with a normal
HCO3 indicates that the cause is respiratory in nature, signifying respiratory acidosis.
2. The nurse is caring for a patient with a serum potassium level of 6.2 mEq/L.
Which EKG change is most characteristic of this finding?
A. Prominent U waves
B. Shortened PR interval
C. ST-segment depression
D. Tall, peaked T waves
Answer: D
Rationale: Hyperkalemia (K+ > 5.0 mEq/L) commonly manifests as tall, peaked T waves,
widened QRS complexes, and potentially cardiac arrest if untreated.
,3. Prior to surgery, the patient has not signed the informed consent form. The
surgeon has explained the procedure, but the patient asks the nurse, ‘What are
the risks again?’ What is the nurse’s best action?
A. Explain the risks to the patient and have them sign.
B. Notify the surgeon that the patient needs further clarification.
C. Ask the patient’s spouse to sign the form.
D. Witness the signature since the surgeon already spoke to them.
Answer: B
Rationale: While the nurse can witness a signature, it is the surgeon’s responsibility to
provide the explanation of risks and benefits. If the patient is unclear, the surgeon must be
recalled.
4. During the intraoperative phase, a patient develops muscle rigidity, a rapid
rise in body temperature, and tachycardia. Which medication should the nurse
anticipate administering?
A. Dantrolene sodium
B. Naloxone
C. Atropine sulfate
D. Succinylcholine
Answer: A
Rationale: These are classic signs of Malignant Hyperthermia, a life-threatening reaction to
general anesthesia. Dantrolene is the specific skeletal muscle relaxant used to treat it.
, 5. A nurse is assessing a patient 2 hours post-cholecystectomy. The patient
reports severe abdominal pain and the nurse notes the surgical dressing is
saturated with bright red blood. What is the priority nursing action?
A. Reinforce the dressing and document the findings.
B. Check the patient’s blood pressure and heart rate.
C. Apply an abdominal binder tightly.
D. Change the dressing to a sterile one.
Answer: B
Rationale: Saturated bright red drainage (hemorrhage) requires an immediate assessment
of hemodynamic stability (vitals) to check for shock before notifying the surgeon.
6. Which clinical manifestation is most indicative of Right-Sided Heart Failure?
A. Pulmonary crackles
B. Dyspnea on exertion
C. Peripheral edema and JVD
D. Orthopnea
Answer: C
Rationale: Right-sided heart failure causes systemic congestion, leading to jugular venous
distention (JVD), dependent edema, and hepatomegaly.
7. A patient with COPD is receiving oxygen via nasal cannula at 2L/min. Why
must the nurse be cautious about increasing the flow rate to high levels?
A. It will cause immediate oxygen toxicity.
B. High flow rates cause severe epistaxis in COPD patients.
C. It may suppress the patient’s hypoxic drive to breathe.
D. It will lead to metabolic alkalosis.
Answer: C
Rationale: In some patients with chronic hypercapnia, the stimulus to breathe shifts from
high CO2 to low O2 (hypoxic drive). Excessive O2 can decrease respiratory effort.
